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Comparison among adjuvant treatments for primary pterygium: a network meta-analysis
  1. Ellen Carrara Fonseca1,
  2. Eduardo Melani Rocha1,
  3. Gustavo Viani Arruda2
  1. 1 Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
  2. 2 Department of Radiotherapy, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
  1. Correspondence to Professor Ellen Carrara Fonseca, Rua Plinio Amaral, 612 Casa 51, Jardim Itaipu Marilia, SP, Brazil; ellencarrara{at}


Purpose Pterygium is a frequent ocular disease, where the major challenge is the high level of recurrence after its surgical removal. We performed a network meta-analysis to identify, among several adjuvant treatments for primary pterygium, which is the best to prevent recurrence.

Methods A search was conducted using PubMed, Scientific Electronic Library Online, Latin American and Caribbean Centre on Health Sciences and Cochrane Eyes and Vision Group Trials Register between 1993 and 2015 for randomisedclinical trials (RCTs) comparing adjuvant treatments following primary pterygium surgery.

Results 24 RCTs that studied 1815 eyes of 1668 patients were included and allowed direct and indirect comparison among 14 interventions through network meta-analysis. The rank from the best to worse treatment to prevent recurrence is: conjunctival autograft + ciclosporin 0.05% eye drops, bare sclera + intraoperativemitomycin C (MMC) <0.02%, bare sclera + beta therapy (2500 cGy single dose), conjunctival autograft + beta therapy (1000 cGy single dose), bare sclera + MMC 0.02% eye drops, conjunctival autograft, bare sclera + intraoperative MMC >0.02%, bare sclera + ciclosporin 0.05% eye drops, bare sclera + intraoperative 5-fluorouracil 5%, amniotic membrane transplantation, bare sclera + intraoperative MMC 0.02%, conjunctival autograft + bevacizumab 0.05% eye drops, bare sclera + bevacizumab 0.05% eye drops and bare sclera alone.

Conclusion The best adjuvant treatment to prevent recurrence after primary pterygium surgery is the association of conjunctival autograft and ciclosporin 0.05% eye drops. Bare sclera technique alone should be discontinued since it is associated with high recurrence rates.

  • conjunctiva
  • ocular surface
  • treatment surgery
  • treatment medical

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  • Contributors ECF: data collection, analysis and manuscript writing. EMR and GVA: project planning, data analysis and manuscript writing.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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